Provider Demographics
NPI:1548779127
Name:SEBASTIAN, CATHERINE ANN DIANCO (MS, RD)
Entity Type:Individual
Prefix:
First Name:CATHERINE ANN
Middle Name:DIANCO
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SOVEREIGN DR
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-0229
Mailing Address - Country:US
Mailing Address - Phone:201-602-5630
Mailing Address - Fax:
Practice Address - Street 1:16 SOVEREIGN DR
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-0229
Practice Address - Country:US
Practice Address - Phone:201-602-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86054961133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered